Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

Abstract

Background Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. MethodsMen and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. Findings The mean INTERHEART risk score of all communities was 17•2 (SE 0•2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0•0001). Socioeconomic advantage (-1•4 score, 95% CI -2•5 to -0•3; p=0•01), trust between neighbours (-0•7, -1•2 to -0•3; p=0•003), higher education level (-1•9, -2•9 to -0•8, p<0•001), and higher social support (-1•1, -2•0 to -0•2; p=0•02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2•2, 0•3 to 4•1, p=0•02), taking prescription medication (3•5, 2•8 to 4•3; p<0•001), and inability to afford prescription medications (1•5, 0•5 to 2•6; p=0•003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. Interpretation Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing.

Association between Social Trust and Metabolic Syndrome in a Previously Healthy Population—A Longitudinal Cohort Study in South Korea

“…Previous studies have investigated the association between social trust and proxy measures of MetS. In a Canadian paper that investigated the causes of health inequality, Indigenous people with higher social support were associated with a lower cardiovascular disease risk score [ 21 ]. Another study conducted with Americans aged 50 years and older, found a statistically significant association between higher perceived social cohesion and a lower incidence of stroke [ 22 ].…”

Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program

“…37,38 Recently, Anand and colleagues demonstrated that within FN communities across Canada, communities with greater trust among community members, higher socioeconomic status, higher social support, and higher education had lower rates of CVD risk factors. 39 Poorer medication literacy also positions Indigenous peoples at a disadvantage in receiving care; in an urban Indigenous health centre, Smylie and colleagues found that individuals with or at high risk of CVD had low CVD medication knowledge, placing them at risk for medication errors. 9 Encouragingly, implementation of an education program, which was delivered by a trained Indigenous nurse and included a tablet application, pill card, and booklet, was demonstrated to a significantly improve medication knowledge.…”

Prevalence of Cardiovascular Disease Risk Factors in an Indigenous Vedda Community in Sri Lanka: Do These Communities Need a Targeted Health Promotion Strategy?

“…20 More recent study involving Canadian First Nations communities (indigenous population) in 2018 showed that poor education, racism, di culty accessing routine health care and not having access to a primary health care provider are some of the risk factors associated with higher rates of cardiovascular disease. 19 Furthermore, it was revealed that greater the burden of socioeconomic hardship, the greater the burden of cardiovascular risk factors for a given community. 19 In a central Australian aboriginal community in 2009, depression and unemployment were identi ed as risk factors for having increased risk for cardiovascular disease.…”

“…19 Furthermore, it was revealed that greater the burden of socioeconomic hardship, the greater the burden of cardiovascular risk factors for a given community. 19 In a central Australian aboriginal community in 2009, depression and unemployment were identi ed as risk factors for having increased risk for cardiovascular disease. 20 In Sri Lanka, these scattered groups of indigenous populations are undergoing demographic transition (9.9% elders above 65 years in our study vs. 8.1% nationally).…”